Laserfiche WebLink
ONSITE WASTEWATER TREATMENT SYSTEM PERMIT <br /> SAN JOAQUIN COUNTY ENVIRONMENTAL HEALTH DEPARTMENT 1868 E.HAZELTON AVENUE-STOCKTON CA 95205-(209)468-3420 <br /> NON-REFUNDABLE PERMIT /►CALL 209)953-7697 FOR INSPECTIONS EXPIRES 1 YEAR FROM DATE ISSUED <br /> JOB ADDRESS L n -5­1J �" J 1 1�+Vn . I + ti� CITY/ZIP <br /> T <br /> CROSS STREET �I/V1/,�jAPN `� ! PARCEL SIZE t r p <br /> C <br /> OWNER NAME L I e- JA r t 1! '&\4i k .��� }') PHONE Gtr t <br /> OWNER ADDRESS n)-,)1r, CITY/STATE/ZIP j&� t •�i^�7Y ( S�[�' <br /> CONTRACTOR Y'y, ,��iC 2_+S �'�f.(/�1� �� r PHONE <br /> CONTRACTOR ADDRESS �� ( -^ / _ A) CITY/STATE/ZIP p"Y fC yL <br /> LICENSE FI-C-42 ❑r C-36 OTHER NUMBER (;1:Y-_,",_0571f EXPIRATION DATE <br /> WATER TABLE DEPTH: ft GEOGRAPHICAL INFORMATION: Coordinates X Y <br /> ❑ PERC TEST # BUILDING PERMIT# LAND USE APPLICATION# <br /> TYPE OF WORK: NEW INSTALLATION 4, <br /> REPAIR/ADDITION ENGINEER DESIGNED/ALTERNATIVE <br /> REPLACEMENT I OUT-OF-SERVICE SEPTIC SYSTEM DESTRUCTION <br /> INSTALLATION WILL SERVE: RESIDENCE ❑ COMMERCIAL ❑ OTHER <br /> NUMBER OF LIVING UNITS: NUMBER OF BEDROOMS: 3 NUMBER OF EMPLOYEES: <br /> ❑ SEPTIC TANK TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> ❑ GREASE TRAP TYPE/MFG CAPACITY gal #OF COMPARTMENTS <br /> DISTANCE To NEAREST: WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ LIFT STATION SIZE TYPE OF PUMP ❑ PKG TX PLANT ❑ SAND OIL SEPARATOR(ENCLOSED SYSTEM) <br /> ❑ LEACH LINES LEACHING CHAMBERS #OF LINES LENGTH OF LINES ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> 0 FILTER BED WIDTH ic� I ft LENGTH -;LH I ft DEPTH /Q,i 1 ft <br /> DISTANCE TO NEAREST WELL I ft FOUNDATION 1 J+ ft PROPERTY LINE 5:' ft <br /> ❑ MOUNDED WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ SUMPS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ DISPOSAL PONDS WIDTH ft LENGTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> ❑ SEEPAGE PITS NUMBER WIDTH ft DEPTH ft <br /> DISTANCE TO NEAREST WELL ft FOUNDATION ft PROPERTY LINE ft <br /> I HEREBY CERTIFY THAT I HAVE PREPARED THIS APPLICATION AND THE WORK WILL BE DONE IN ACCORDANCE WITH SAN JOAQUIN COUNTY ORDINANCES, <br /> STATE LAWS AND RULES AND REGULATIONS OF SAN JOAQUIN COUNTY. <br /> MINIMUM 48 HOUR ADVANCE NOTICE REQUIRED FOR INSPECTIONS - PLEASE CALL 20 953-7697 <br /> SIGNED TITLE G;L,f r10 ' t] 'S DATE j-4?4_ <br /> 1 <br /> DK <br /> O <br /> 1 R <br /> pFLAT <br /> DEPARTMENT USE ONLY <br /> Application Accepted y Date Area Employee ID# <br /> Final Inspection By DateZ�J cj //?�J%v)%v) ❑ SPECIAL PERMIT-Approved by <br /> Character of Soil to Depth of 3 Ft Pit/Sump Soil Character: r <br /> COMMENTS M71 <br /> 2 <br /> PE Sc Received Amount Date Permit/ Invoice# Permit ID# <br /> Code INFO B Cash Remitted Service Request# <br /> 3i I� <br /> 42-01 ONSITE WASTEWATER TRTMNT SYSTEM PERMIT <br /> 4/14/18 <br />